Provider First Line Business Practice Location Address:
10153 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-8206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-213-1588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2013